Reattachment of soft tissue to bone employing knotless fixation devices are known in the art, particularly for the formation of double row constructs in arthroscopic rotator cuff repairs. For example, the SutureBridge™ tendon repair technique, developed by Arthrex, Inc., and disclosed in U.S. Patent Publication No. 2007/0191849, the disclosure of which is herein incorporated by reference, consists of a tied medial row constructed with two threaded suture anchors, combined with knotless lateral fixation using two Arthrex PushLocks®.
As detailed in U.S. Patent Publication No. 2007/0191849, the construct (shown above) is formed by first preparing two pilot holes for two suture anchors (with suture strands attached) that will be inserted in the medial row. Once the two suture anchors are placed in the pre-formed holes, suture tails from the suture anchors are draped over the tendon and threaded through respective eyelets of two knotless fixation devices (such as Arthrex “PushLock” C anchor, as disclosed and described in U.S. Pat. No. 7,329,272, the disclosure of which is hereby incorporated by reference in its entirety). Two pilot holes are formed (lateral from the two medial pilot holes) to accommodate the two knotless fixation devices with the suture tails threaded therethrough. A driver (with a screw inserted on a rod of the driver) is advanced to the edge of each pilot hole and used to install each knotless fixation device (and the corresponding screw) within the pilot hole to form the final construct (shown above) having an exemplary criss-cross suturing configuration. The construct enhances footprint compression and promotes tendon healing-to-bone with decreased knot tying.
The SutureBridge™ technique described above may be optionally employed in conjunction with an implant material (such as a graft or a patch of allograft or porous collagen material, that may be optionally hydrated with bone marrow aspirate), as also described in U.S. Patent Publication No. 2007/0191849. The implant material (graft or patch) is provided arthroscopically (preferably under the tissue or above the tissue) prior to implanting the lateral row of the repair system. Incorporation of the biological patch or graft underneath the tissue (for example, underneath the rotator cuff) during arthroscopic surgery necessitates the insertion of fixation devices (such as suture anchors, for example) through the patch or graft. The insertion of these fixation devices may be difficult, however, as the graft or patch is introduced and held at the surgical site in a free state which requires increased handling and instrumentation. Accordingly, a knotless double row construct with increased graft or patch fixation at the repair site is needed.